With great interest, and occasional dismay, I've read through the posts on this thread. I think it is fair to say that most of you agree that most of the physicians in the military are above average to exceptional. I would agree with that statement. Most of the negative comments I read were directed at poor management or individual circumstances that were, to refrain from more colorful language, sub-optimal.
I am an active duty Army physician and started my military career about 15 years ago at West Point. I attended USUHS and did a military residency (FP). Since I am a primary care physician, I will avoid commenting on the surgeon specific issues listed in other posts for I do not have the expertise nor personal experience to comment on those issues. What I intend to do is give those of you considering military medicine a different viewpoint from what I've seen on this blog. Furthermore, for those still in the service who are upset or frustrated with their current situation, I give a few helpful suggestions. For those of you who have completed their service (whether your opinions of the military are positive, negative, or a mix, thank you for your service).
Although the military medical system is not perfect, it provides excellent care to the active duty, dependent, and retiree population on a daily basis. Sure, administrative and personality issues arise, but unfortunately this exists in almost all work environments (from a solo provider office to a lofty academic major medical center). What truly separates the path of the military physician from one in the civilian sector is being part of a bigger system: the system that protects the national interests of this country. Without diverging too much into national security strategy and DoD's role, we military physicians are able to serve individually as service members as well as taking care of the Soldiers, Sailors, Airmen, and Marines.
Some of the comments in other posts relate to poor leadership and management situations. Those are of course unfortunate, but one of the other unique aspects of being in the military as a physician is that we are also officers. Our role as officers is to find better ways for the system to function, to find alternative strategies for dealing with people, and discovering new ways to solve old problems. I certainly don't believe that anyone out there thinks that the civilian system is perfect and when looked at from a bigger picture, the military system is pretty good. We are paid well, respected for our opinions, and given the opportunity to branch out into other areas than just clinical medicine (if you so choose). The systems in place also encourage professional growth (basic course, advanced course, and CGSC/ILE). The medical departments want (need) officers of character that instead of simply stating how "bad" things are, take action to improve the situation. Any organization that continually wants to improve its employees (i.e. making short term sacrifices for long term benefit) is one that has its priorities in order.
I appreciate you taking the time to read this and I look forward to your responses. Hopefully for those of you thinking of joining our profession of arms, this encourages you to make the commitment.

MAJ Matt Fandre, ILE Class 09-001

The comments in the posting are my own. They do not reflect the views of the US Army Medical Department, CGSC, The Department of the Army, or the Department of Defense.

I think it is fair to say that most of you agree that most of the physicians in the military are above average to exceptional.

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I would generally agree with this. What do you think of the drop in recruiting standards? Ten years ago, all the HPSP scholarships filled and there was competition between applicants from top tier medical schools. Now military medicine has opened the doors to FMGs who are American citizens.

I am an active duty Army physician and started my military career about 15 years ago at West Point. I attended USUHS and did a military residency (FP).

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Is it fair to say you have a significant bias? You have a vested interest in marketing military medicine. Having attended a service academy and USUHS you owe at least 12 years of payback. You've basically committed yourself to 20 years in the Army.

The medical departments want (need) officers of character that instead of simply stating how "bad" things are, take action to improve the situation.

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At a conference I attended, a flag officer said one of the problems contributing to poor retention is that senior medical officers put themselves in protected administrative positions while at the same time throwing junior physicians under the bus. As the churn rate increases, it becomes easier and easier for those remaining to get promoted compounding the character and leadership problem.

To address this issue, we need to change the way that medical officers are promoted and picked for leadership positions: 1/3 of promotion points needs to come from subordinates/peer evaluations and another 1/3 needs to come from patient evaluations. With a 360 degree evaluation system, physicians who have a poor bedside manner or who have a habit of throwing subordinates under the bus wouldn't last long.

Hopefully for those of you thinking of joining our profession of arms, this encourages you to make the commitment.

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It's interesting that you used the terminology "our profession of arms" especially given the Hippocratic Oath we all took to do no harm. Do you see yourself as a soldier or physician? At another conference, a flag officer introduced himself as a "former physician". I feel solid in my identity as both a physician and an officer. I have no desire to cast my professional identity aside.

We are paid well, respected for our opinions, and given the opportunity to branch out into other areas than just clinical medicine (if you so choose).

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I would have loved to have done "just" clinical medicine, but they yanked me and half my graduating class out of residency to fill all the GMO billets vacated en masse by our predecessors. At no point in the above chain of events did the military impress me with its planning ability, concern for my training, or its concern for the active duty folks who will be seeing an "attending" internship-trained physician who (though he tries hard) wouldn't be allowed to see patients as independently as I do anywhere in the US, and for good reason. Every day I see clinic I'm terrified that I'm going to make a mistake and injure someone because I don't have the necessary training to deal with the problems I encounter. How long do you think that young physicians will stay with an organization that regularly puts them into this kind of situation as a matter of policy?

I am glad you've had a good experience and hope that you continue to do so in the future. Unfortunately you are part of a rapidly shrinking minority. Good luck.

With great interest, and occasional dismay, I've read through the posts on this thread. I think it is fair to say that most of you agree that most of the physicians in the military are above average to exceptional. I would agree with that statement.

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Dr. Fandre, welcome to the forum, and if you have really read through, you will realize that we post out of care and concern for what has happened to military medicine, and how it affects the soldiers and their families. I would agree that the vast majority of average to exceptional physicians are new to the system, and that once they go through it, the vast majority leave because of the circumstances they are under. I do agree there is a minority of senior level phycisians who have managed to keep their competence and influence.

Most of the negative comments I read were directed at poor management or individual circumstances that were, to refrain from more colorful language, sub-optimal.

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Although alot of the complaints are directed at poor management, that management comes from the very top, and I would argue that is one of the root causes of the problems milmed faces today.

Although the military medical system is not perfect, it provides excellent care to the active duty, dependent, and retiree population on a daily basis.

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I would argue based on my 6 year surgical experience, the multiple experiences of fellow phycians, the multiple printed articles, and previous exposes of military medicine, (http://www.pulitzer.org/works/1998,National Reporting) being the most famous one, that they are not getting excellent care and at times they get substandard care. This is not a dig at you or A1, but it comes from my collective experience. I'm sure that you and others bend over backwards to give this excellent care, and I'm happy that you so far have been able to provide it.

Sure, administrative and personality issues arise, but unfortunately this exists in almost all work environments (from a solo provider office to a lofty academic major medical center).

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The biggest difference being that if the environment is so toxic to your being, you can just leave. Also, in the civilian environment, if a physician is clearly dangerous, the law intervenes, or they do not see patients. Not the case in the military based on my experience, though others have posted different experience.

What truly separates the path of the military physician from one in the civilian sector is being part of a bigger system: the system that protects the national interests of this country. Without diverging too much into national security strategy and DoD's role, we military physicians are able to serve individually as service members as well as taking care of the Soldiers, Sailors, Airmen, and Marines.

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Agreed, but what happens when you believe and experience that the system is failing?

Some of the comments in other posts relate to poor leadership and management situations. Those are of course unfortunate, but one of the other unique aspects of being in the military as a physician is that we are also officers. Our role as officers is to find better ways for the system to function, to find alternative strategies for dealing with people, and discovering new ways to solve old problems.

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What happens when you go through all the right channels and find yourself at the loosing end of the stick like this guy in MO. Or many of the problems I faced. What happens when the system fails to address critical issues you present, no matter how well, or diplomatic you present them?

I certainly don't believe that anyone out there thinks that the civilian system is perfect and when looked at from a bigger picture, the military system is pretty good.

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The civilian system is far from perfect, but the military system has degraded so much that its not even a comparison.

We are paid well, respected for our opinions, and given the opportunity to branch out into other areas than just clinical medicine (if you so choose). The systems in place also encourage professional growth (basic course, advanced course, and CGSC/ILE).

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The paid well is misleading. Only if you are primary care or pediatrics you may be close to the civilian pay, but medical subspecilties, and all surgical subspecialties make SIGNIFICANTLY less than civilian conterparts. Furthermore, as many here can attest to, sometimes you are not given the opportunity to become a manager, but its the ultimate goal of the organization, as I have seen it described by the surgeon general. The majority of us got into medicine to practice medicine, not become a professional soldier.

The medical departments want (need) officers of character that instead of simply stating how "bad" things are, take action to improve the situation. Any organization that continually wants to improve its employees (i.e. making short term sacrifices for long term benefit) is one that has its priorities in order.

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I covered this, and I do not think the military has the priority of physicians in mind.

I appreciate you taking the time to read this and I look forward to your responses. Hopefully for those of you thinking of joining our profession of arms, this encourages you to make the commitment.

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I hope they join because they want to be phycisians, and know what they are getting into. I also look forward to seeing your responces to our comments, and hope you continue to post your experiences. Also thank you for your service.

The paid well is misleading. Only if you are primary care or pediatrics you may be close to the civilian pay, but medical subspecilties, and all surgical subspecialties make SIGNIFICANTLY less than civilian conterparts. Furthermore, as many here can attest to, sometimes you are not given the opportunity to become a manager, but its the ultimate goal of the organization, as I have seen it described by the surgeon general. The majority of us got into medicine to practice medicine, not become a professional soldier.

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I think the Major's point here is that we're well paid, not that you're better paid than your civilian counterparts. In other words, no medical officer in the military is just scrapping by or starving (unless they're financially irresponsible, that's another story).

Also, I think it's quite debatable, the whole civi. vs mil med pay situation. A lot of people on the civi side think MD pay is going to take a drastic turn for the worse, per managed care. Some of the truly invasive docs (like surgeons) will continue to be paid handsomely (and they deserve it, they do a lot of work!). But other specialties might take a hit. . . Who knows, it can be argued several ways.

In any case, the civilian equivalent of any officer's job probably makes more money, no matter what the job. I was a scientist of sorts in the Navy, my civilian equiv. made a lot more (I could've taken a civi job in Silicon Valley, chose not to), civi engineers, lawyers, MBAs all make more money than those doing equivalent jobs in the military.

So it stands to reason that you shouldn't be joining the military if you want to make a lot of money. You should be joining b/c of your desire to serve.

Major, thank you for your comments, and for signing your name at the bottom. You willingness to do that adds a lot more weight to you opinion, and that's especially influential to those of us that are thinking about joining the medical corp. I hope I can do the same some day (reveal my identity) . . . I just need to build up more mojo

Major, thank you for your comments, and for signing your name at the bottom. You willingness to do that adds a lot more weight to you opinion, and that's especially influential to those of us that are thinking about joining the medical corp.

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That's probably faulty logic.

The only active folks who will abandon anonymity are those who will be making pro-milmed posts. Identifying yourself by name and then pointing out all of the flaws of milmed would be a very bad idea. So I wouldn't add any value to folks who identify themselves by name. It's just their way of saying that they will be making posts supportive of the current milmed environment.

That said, I enjoyed your post, Major. You'll soon find around here that the lion's share of those who are positive about the current state of military medicine are medical students and residents. It's nice to see someone with actual experience who is positive about the state of things.

1. What doctor would add the fact that he is a ILE student to his signature? Very odd. The letters I would care to put after my name are MD, FACP, FACG, etc. I just think the fact that he finds that so important that it is part of his signature reflects a massive disconnect with the priorities of the typical physician (in the military or out).

2. The "professional growth" he mentions has nothing to do with the practice of medicine. I can't get funding to go to a national meeting but the military will pay for a doctor to sit for weeks in these courses. I think that shows the relative value that the military places on maintenance of my real professional skills.

3. Major, how many times and for how long have you deployed since finishing training 4ish years ago?

4. Most of my frustrations with military medicine are simply so far above my paygrade that there is no avenue that exists for me to solve them. AHLTA, DHMRSi, 15 mo. Army IA's for navy docs who sit and do nothing, the lack of support staff and nurses, and more. I volunteered and I work hard every day but please don't tell me that I'm just not part of the solution if I'm exhausted by these endless petty frustrations. That sort of condescending BS is what you hear from people who don't acknowledge these are problems.

What doctor would add the fact that he is a ILE student to his signature? Very odd. The letters I would care to put after my name are MD, FACP, FACG, etc. I just think the fact that he finds that so important that it is part of his signature reflects a massive disconnect with the priorities of the typical physician (in the military or out).

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Per ususal SDN conclusion jumping - we have now concluded that this doctor has mixed up priorities....why would he put ILE student on his post?

ILE students now are required to blog - the explicit instructions are that you must include your name, rank and that you are an ILE student. I give him credit for posting it here, as many students post them on blogs where they know the post will never be seen.

I by the way fully agree with his assertions. Being a military physician is very hard, stressful, and at times maddening, but as I have stated earlier there is importance to this path, and those with enough tact, savvy and passion can push changes through.

I'm sorry, how does the fact that this was homework disprove my point that it was odd, reflects priorities disconnected from the vast majority of us or improve his credibility?

And the rest of my points?

You claim dedicated people can effect change. I listed some things I would like changed, make it happen and I will bow before your superior nature. Even better, what have you changed?

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Feeling a little testy there?

I made valid point, you jumpted to a conclusion about this doctor. Deal with it.

Yes, I have made some tangible improvements, both at my clinic, hospital and even possibly at higher levels. I didn't do it by carping.

Lastly, you are very concrete if you believe that professional development only matters when it is directly related to medicine. How about critical thinking, leaderhip, training, expanding your knowledge of your government, the threats if faces, history etc. I'm sorry you can't see any value in that.

I've seen military medicine leaders use statements like this at times. Instead of addressing a perfectly valid issue the leader turns it around on the person who brought up the issue. The notion is that somehow there are no systemic problems, only "leadership issues". Staffing problem? Well it's your fault since you made a "paperwork error" or didn't follow some vague procedure. Maybe the issue resulted from a communication problem on your part. If you just would have used tact when you made the request it would have been fulfilled. How about screen formatting problems on the PowerPoint presentation? The font and background were just to distracting when you gave the briefing. Go home and try again.

I made valid point, you jumpted to a conclusion about this doctor. Deal with it.

No, its an odd signature for a doctor. I didn't know that it was because he was posting here as a homework assignment but that doesn't change my assessment.

Yes, I have made some tangible improvements, both at my clinic, hospital and even possibly at higher levels. I didn't do it by carping.

Sure.

Lastly, you are very concrete if you believe that professional development only matters when it is directly related to medicine. How about critical thinking, leaderhip, training, expanding your knowledge of your government, the threats if faces, history etc. I'm sorry you can't see any value in that.

Insults and sarcastic apologies aside, sure there is some marginal value in that list. It's the relative prioritization of that list over basic graduate/continuing medical education that bothers me.

Feel free to attack again, this is my last response. I just did a little search and realized that this is all troll-food.

I've seen military medicine leaders use statements like this at times. Instead of addressing a perfectly valid issue the leader turns it around on the person who brought up the issue. The notion is that somehow there are no systemic problems, only "leadership issues". Staffing problem? Well it's your fault since you made a "paperwork error" or didn't follow some vague procedure. Maybe the issue resulted from a communication problem on your part. If you just would have used tact when you made the request it would have been fulfilled. How about screen formatting problems on the PowerPoint presentation? The font and background were just to distracting when you gave the briefing. Go home and try again.

LOL

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I think its a few times that the LOL monicker is followed when reading a post. I found myself chuckling at this becase, as Homer says: "it funny cause its true". I'm pretty sure that's a direct quote, but I haven't watched the Simpsons for a few years now.

The fact is that this is a standard tactic. I do not think it matters how tact you are, how much you know about the sport the one making the decision happens to like, its often above their paygrade, yet they do not want to seem not able to handle it. In making a generalization, the only hospital commander who sat down and listened, and clued you in as to how really constrained they are, was an orthopoedic surgeon who was one of these "exeptional" people I speak about, that stayed in and made little bits of difference around him, but that was it.

The argument we may be falling into is how much change is it that we can affect, even being masterfully tactical in human communication and conflict resolution. What constitutes a change to me, is something radically different than what constitutes a change to someone else. For me, I think we need RADICAL, and COMPLETE change that the DoD is just not prepared to make. So these debates will continue, though based on different perspectives.

????How is it that it was homework for Dr. Fanre to post??? I missed that somewhere.

????How is it that it was homework for Dr. Fanre to post??? I missed that somewhere.

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Maybe you have A1 blocked, not a bad idea (is this dude really an MD?). He posted above that ILE students are "required to blog."

Speaking of which, Dr Fandre, you've sparked some discussion. Any response? I'd particularly like to hear your thoughts on how an O4 can impact AHLTA, pay discrepancies for subspecialists, and lack of support staff.

Hello everyone, Sorry to have not responded earlier, but I was enjoying some good family time over the Thanksgiving holiday...I hope you all were able to enjoy the weekend as well. I'll try to answer all the above questions without writing a 3 page paper (I get to do plenty of those here in class).

As a1 referred to, I am in ILE and it is a requirement to contribute to a blog and post our name and class number. That being said, I'm not one to define myself by any of the letters I can put after my name. I enjoy being a physician and an officer and don't believe that they are mutually exclusive. Rather, I think they can work quite well together. I very much enjoy being a physician in the military and enjoy the challenges, responsibilities, and opportunities afforded by both. There is no conflict between the Hippocratic Oath and the oath I took as an officer. Simply put, my job is to do all I can to take care of my patients; I will use the weapons on which I'm trained to defend myself and my patients, but since I won't be doing offensive operations, I see no contradiction with "first do no harm." In reference to why a doctor would "need" ILE (or any leadership classes) and that they are simply stereotyped approaches, I think it is better to look why these opportunities are beneficial. In both the civilian world and in the military, these courses exist to try to make us better at doing our jobs. Not everyone is interested in commanding a hospital or running a clinic. However, some of us are interested in trying to make the system work better while in those roles and these classes serve that function. Even the approaches that seem too simple to work in real situations can be used as a reference point. Gastrapathy, I'm sorry to hear that you haven't been able to get funding for CME. I know that it is a goal for all Army physicians to get to at least one paid CME a year. Of course, mission comes first and due to deployments and patient demand it is sometimes difficult to go, but most docs I know have been able to go, even if just for a weekend course. To answer one of the other questions, I've deployed 5 times. It's been challenging at times and thank God for my incredible wife. How she manages my deployments, 2 children, and residency is beyond me, but I'm awfully indebted to her. I love what I do, despite the challenges. I realize that I could make more money on the outside (and for those of you in surgical specialties, the difference is even greater), but the extra cash in my pocket isn't more valuable than being able to serve my country and take care of the men and women that volunteered to do the same. I love that I don't have to deal with the alphabet soup of HMO/PPO/BC/BS/etc. I know that my patients can get the medications they need and normally the system is pretty painless. AHLTA may not be perfect, but it isn't that bad either; I like it a whole lot more than not having an EHR. Finally, Galo I appreciate the references to the Pulitzer prize website. There is no doubt that mistakes were made in the past. Those things should have never happened and sub-standard-of-care should not be tolerated in any health care system. However, changes have been made and our healthcare system is better now than it was before. Those events happened 10 years ago; I think it is dangerous to continue to judge the system from mistakes a decade ago. There are great people everyday working to make things better and changes can occur; our responsibility to continually effort those improvements. I look forward to hearing from you all; thank you for all of your service. Medicine is definitely an art and I'm glad that intelligent and dedicated folks like you are wielding the brush.
Matt

Maybe you have A1 blocked, not a bad idea (is this dude really an MD?). He posted above that ILE students are "required to blog."

Speaking of which, Dr Fandre, you've sparked some discussion. Any response? I'd particularly like to hear your thoughts on how an O4 can impact AHLTA, pay discrepancies for subspecialists, and lack of support staff.

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Sorry Gastrapathy, didn't see your last entry when I wrote earlier. Although I'd like to say I can change it all tomorrow (don't we all), I believe the way we can change things is three-fold:

1) Maintain the proper focus in our own clinics and those we work with. Disgruntled, unhappy, and unfocused players will make the situation worse. We must actively improve our clinics, recruit medical student and residents to the military, retain the great folks with whom we serve, and train to the right standards.

2) Influence those in our chains-of-command. To do this, we have to come with well reasoned solutions that focus on the true issues such as staffing and patient empanelment.

3) Keep fighting the good fight until we may be in positions where we can make change. This doesn't require being surgeon general: branch managers, hospital commanders, and those that work on the surgeon general's staff have large amounts of influence. To make some of the big changes that will benefit our system requires having people in key positions of influence. If we aren't willing to get immersed in the system, then there is no chance for some of the changes to be made.

1) Maintain the proper focus in our own clinics and those we work with. Disgruntled, unhappy, and unfocused players will make the situation worse. We must actively improve our clinics, recruit medical student and residents to the military, retain the great folks with whom we serve, and train to the right standards.

2) Influence those in our chains-of-command. To do this, we have to come with well reasoned solutions that focus on the true issues such as staffing and patient empanelment.

3) Keep fighting the good fight until we may be in positions where we can make change. This doesn't require being surgeon general: branch managers, hospital commanders, and those that work on the surgeon general's staff have large amounts of influence. To make some of the big changes that will benefit our system requires having people in key positions of influence. If we aren't willing to get immersed in the system, then there is no chance for some of the changes to be made.

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What do you think about starting a non-profit organization to advocate for change in the military medical system? I think if it was simple as getting immersed in the system and waiting for the opportunity to impact change it would have already been done.

Finally, Galo I appreciate the references to the Pulitzer prize website. There is no doubt that mistakes were made in the past. Those things should have never happened and sub-standard-of-care should not be tolerated in any health care system. However, changes have been made and our healthcare system is better now than it was before. Those events happened 10 years ago; I think it is dangerous to continue to judge the system from mistakes a decade ago.

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I'm not sure I agree with you. One of my mentors said "the wheels are coming off this organization". I think things are deteriorating.

As for the idea of an organization outside the military, that would be tricky to say the least and I don't think it would be received very well by those who have the authority to make changes. I do think that those of us that are the next wave of officers need to work together to do our duty to let our bosses know the real issues (unfortunately, as I'm sure you and most people reading this realize, it sounds so much easier than it really is).

I believe the major underlying issue is that we don't have enough providers. Only Congress can change the number of physicians and obviously that is a process that will take time.

Out of curiosity, are you Army? Glad to hear that you have a mentor; mine is invaluable to me.

I'm not sure I agree with you. One of my mentors said "the wheels are coming off this organization". I think things are deteriorating.

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Is the command happy? Is the line happy? Everything I've read says, "Most of them."

If the docs are the only ones unhappy, the organization is doing just fine and nothing will much change over the course of my career. The day the customers start revolting, things will change in a hurry.

Is the command happy? Is the line happy? Everything I've read says, "Most of them."

If the docs are the only ones unhappy, the organization is doing just fine and nothing will much change over the course of my career. The day the customers start revolting, things will change in a hurry.

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I've noticed that on this thread, and the one IDG started asking what should be changed, or what would make milmed better, you have adopted the stance that nothing will change, and therefore have pretty much reached learned helplessness at the residency level. Many attendings don't reach that till they've banged their heads for a year or two. This is in no way a dig at you. In a way, you will likely not be dissapointed as you have set your expectations of what milmed is and will become quite low.

I guess this has become one of the central themes of this forum lately. What can we do to make things better? Some of us feel we tried everything and failed miserably. The one's that are in and positive, feel they have made some change, or will be able to make some change.

But reality speaks for itself. Retention is at its lowest, satisfaction by physicians is at its lowest, morale by physicians is exceedingly poor, there is no question even by proponents that there are almost insurmountable problems in milmed today.

I have to agree with you that I also do not think things will change much. The money is not there, we are at war, the concept of the system is not ready for change, certainly the money is not there.

At least by having these discussions we maintain the same goal in mind, to take the best possible care of our soldiers, though we may have a different opinion of what that is, and how to achive it.

PS: the vast majority of soldiers do not need alot of medical care, and when they do, they do not really have a choice of where to get it. Complaining about it is like complaining about PT or deployments, not much is going to change there.

Out of curiosity, are you Army? Glad to hear that you have a mentor; mine is invaluable to me.
Matt

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I think I'm the only Army doc who has replied to this string. The rest - correct me if I"m wrong are mainly former USAF or USN, a few active USN and USAF.

There is no arguing that the USAF are unhappy, the USN somewhat less so.

Thanks for your post. You get the big picture, and I appreciate it.

Neither of us have denied there aren't problems are frustrations, but I think we both have made the point, that soldiers, airmen and sailors (and marines) deserve docs who are committed to them and their welfare despite the fact this may come at the cost of less pay, more seperations from family and other military specific headaches.

I certainly hope, but also believe that things aren't deteriorating.
Matt

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I agree. Unlike the stock market I think we've hit bottom (recruiting/retentionwise), this is evidenced by better recruitment numbers, and some increased money in the system. If deployments slow down to a more manageable rate, we will be ok..

very interesting thread... so happy I found it in time. Now, I will be better able to make a well informed decision, and not just what I'm told by the recruiter. (The very first time I heard from him, it sounded too good to be true).
Thank you all.

I agree. Unlike the stock market I think we've hit bottom (recruiting/retentionwise), this is evidenced by better recruitment numbers, and some increased money in the system. If deployments slow down to a more manageable rate, we will be ok..

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when retention approaches 0%, its hard to argue with the statement that we've reached rock-bottom.

I haven't posted in a while but I got a private message and reclaimed my password to respond.
I got out of the AF in June 06 and probably had 6-9 months where I used to think on my way to work how thankful I was not to be going to the AF hospital. It really was so very depressing. I think it was much more depressing than grinding during the six years of residency which I did.

I remember being so angry and frustrated at
1) the way I was treated
2) the way our patients were treated by our hospital commanders
3) the disregard to patient and physician wellness
4) the time and resource wasting
5) the ridiculous rules which served zero purpose
6) how little money I was making in California where the cost of living is so high comparatively

I really thought if I could save somebody the frustration and help them learn from my mistake rather than having them have to go through it I would really be doing a service. After the 6-9 months of coming down the ledge I realized that when someone is young and idealistic and wants to make a stupid choice they just need to do it.

I haven't posted in a while but I got a private message and reclaimed my password to respond.
I got out of the AF in June 06 and probably had 6-9 months where I used to think on my way to work how thankful I was not to be going to the AF hospital. It really was so very depressing. I think it was much more depressing than grinding during the six years of residency which I did.

I remember being so angry and frustrated at
1) the way I was treated
2) the way our patients were treated by our hospital commanders
3) the disregard to patient and physician wellness
4) the time and resource wasting
5) the ridiculous rules which served zero purpose
6) how little money I was making in California where the cost of living is so high comparatively

I really thought if I could save somebody the frustration and help them learn from my mistake rather than having them have to go through it I would really be doing a service. After the 6-9 months of coming down the ledge I realized that when someone is young and idealistic and wants to make a stupid choice they just need to do it.

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Its unfortunate that there are still so many young and idealistic people that go in really not knowing much about what may happen, or with the idea that it could not happen to them. The military feeds off this naivite and keeps selling this junk scholarship to them. I know we have made a small difference, but until they are in a desperate situation, they will not institute any meaningful change. I see this one way revolving door of misery continuing for decades to come.

There are over 135,000 of us serving the men and women who protect our country. Our number one priority is caring for our wounded. Yes, there are still a lot of improvements to be made but we're making strides. There are pros and there are cons to military medicine, as with any job. It's all about the attitude you choose to have and your commitment to service.

On today's MHS podcast, Dot Mil Docs, an Army physician and nurse will be on from Baghdad to discuss the patient safety program and I encourage those who might be considering military medicine to call in and ask questions or post a comment.

2) Influence those in our chains-of-command. To do this, we have to come with well reasoned solutions that focus on the true issues such as staffing and patient empanelment.

Interesting approach. I rememeber when I tried to influence my chain-of-command. I wrote a letter outlining the problems we were having getting proper health care to some of the soldiers on the post and made some suggestions on how to fix it. 2 weeks later, I was relieved of my position and forced to do PT at 0430 every morning with others that had screwed up in some fashion in 30-40 degree weather for 4 weeks. Needless to say, that was the last time I tried to influence the chain-of-command.

2 weeks later, I was relieved of my position and forced to do PT at 0430 every morning with others that had screwed up in some fashion in 30-40 degree weather for 4 weeks. Needless to say, that was the last time I tried to influence the chain-of-command.

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Yes, I'm sure thats exactly what happened. hilarious, what on earth did you recommend???

Yes, I'm sure thats exactly what happened. hilarious, what on earth did you recommend???

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Crazybrancato, you shouldn't be so quick to invalidate this poster's experiences. There have been numerous similar accounts of retribution / passive aggressive behavior written by other posters over the years on this site. When you served in the surface warfare(?) community did you ever see anything like this?

When you served in the surface warfare(?) community did you ever see anything like this?

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of course, but there's always two sides to a story. Or in the complicated world of the military, there's several sides.

my point above is that if we're going to tell anecdotal stories and use them to justify our opinions (pro or con) about milmed, then it would behoove us to give some more details.

simply stating divulging that you wrote a letter of recommendations and got punished for that is unbelievable. Now, if the letter was very condescending, insulting, rude, disrespectful, sent straight to the SG of the USAF . . . then we can see the angle of the CO a little more.

of course, but there's always two sides to a story. Or in the complicated world of the military, there's several sides.

my point above is that if we're going to tell anecdotal stories and use them to justify our opinions (pro or con) about milmed, then it would behoove us to give some more details.

simply stating divulging that you wrote a letter of recommendations and got punished for that is unbelievable. Now, if the letter was very condescending, insulting, rude, disrespectful, sent straight to the SG of the USAF . . . then we can see the angle of the CO a little more.

I wish that I could give more precise details, but I am still on mandatory active duty and fear further retribution. Don't mean to sound melodramatic, but my experiences have made me very hesitant to reveal too much in any forum. I will say that the letter was not condescending or rude in any way and I sent it through my proper chain of command. In the letter, I highlighted the fact that 1 provider could not effetively take care of 2,000 AD soldiers and work full time seeing dependents in the clinic in addition to that. My suggestion to better streamline the care for the soldiers was to make them recipients of care at the clinic like everyone else. This would have helped the soldiers and given the clinic more of the always sought after RVU's. Fine point above that there is always more than one side to a story and perhaps there is a side no one told me about. However, I do know that prior to submitting the letter, when I was working 14-15 hour days 6 days a week, I was getting high reviews and seemed to be on a good track. 2 weeks later, I was no longer working in the position with the AD soldiers and was doing PT in icy winds. Could have been coincidence, but it would be a real odd one. There were also a few senior officers who later apologized for what happened. I wish I could say more.

I am not particularly worried if one person or another on this forum believes me. The reason I signed in is actually not to bash milmed. The funny thing is, I still care a great deal about the future of milmed as this impacts the MC's ability to help soldiers and their families, which is the bottom line point of all we do. I thought that my experiences were isolated ones, but after reading through post after post on here, I see that I am not alone. The problems seem to reach across all branches and specialties. I think my intent on posting my experiences was, as we say in medicine, to add to the body of literature to help bring light to the fact that these problems are very real. We can no longer bury our heads in the sand and hope the system fixes itself. I don't have the right answers to the problem, but I know that something must be done.

you sound like you were from David Grant Medical Center in the USAF.
there punishment was not being deployed. the people who were deployed... aside from missing their families.... generally felt positive, productive, and had good morale. Those at the hospital were punished by being kept within the local system.

We had a surgeon write a letter to the AF Times which was published. He took a lot of crap for speaking the truth. The mafia can't squeeze you as tightly as they could.

you sound like you were from David Grant Medical Center in the USAF.
there punishment was not being deployed. the people who were deployed... aside from missing their families.... generally felt positive, productive, and had good morale. Those at the hospital were punished by being kept within the local system.

We had a surgeon write a letter to the AF Times which was published. He took a lot of crap for speaking the truth. The mafia can't squeeze you as tightly as they could.

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Do you know where I could get a copy of that letter, when it was published.

Although Ive read this string and similar forums in the past, my interactions have always been purely voyeuristicuntil now. Similar to the prior posting by ilestudent, I have been encouraged to blog as a result of my current enrollment in ILE. I am a graduate of the Uniformed Services University (USUHS) and have practiced medicine for over 9 years. Fortunately, I received my first choice for both residency and fellowship (Radiology and Neuroradiology). I have deployed and worked as a department chief. I understand the frustrations of those who joined the military medical system and then find themselves burdened by administrative responsibilities or personal conflict with command. I have likewise watched many of my colleagues leave the military for the greener pastures of private practice. As a product of both military and civilian medical training, though, I have personally witnessed the positives and negatives of each system. Readers may question my intentions secondary to residual military commitment or may see this posting as a way of completing my ILE assignment. That being said, I hope to share my honest opinion on the benefits and drawbacks of military medicine. There are three potential downsides to military medicine that are unlikely to change in the near future. Despite the benefits of a military retirement, for most specialties outside of primary care there are clearly better economic incentives in the civilian sector. I doubt that this gap will be closed anytime soon, regardless of the multi-year bonus structure being offered for additional years of commitment. Obviously, the more time you spend in the military, the more likely you will be asked to perform administrative responsibilities to the possible disadvantage of your clinical practice. In addition, physician deployments are an unfortunate necessity resulting from current overseas engagements. It is easy for physicians to forget, though, that the majority of soldiers we take care of have deployed for much longer periods of time, are less compensated, and live in more austere and dangerous conditions. Although I acknowledge dissenting views on the quality of military medicine, I believe that we provide excellent care to our beneficiaries both on the battlefield and stateside. It is indisputable that the survival rate of soldiers injured on todays battlefield is the highest it has ever been. Military physicians continue to be active participants in essential clinical research as can be witnessed at major medical meetings or by reading the current medical literature. Although personnel shortages and funding limitations can make the practice of medicine challenging in the military, I have not noted a decrement in patient care as a result. Obviously, military medicine is not perfect. It is difficult to find recent comparable outcomes data, but evidence suggests patients are happier with the military medical system than our civilian counterparts (http://www.armymedicine.army.mil/about/quality.html). The process for acquiring new or replacement equipment can be somewhat bureaucratic. Despite this, I have been extremely pleased with my ability to request and acquire state of the art equipment, including some of the big ticket items previously mentioned. It is our responsibility as medical officers to provide world class patient care. By extension, rather than simply complaining about perceived inadequacies and fighting against bureaucracy, it is imperative that medical officers work to improve the system from within. When I start to become frustrated by the current system, I try to remind myself of the biggest benefit of military medicine--our patient population. As an Army physician, I get to care for military beneficiaries, many of whom risk their lives for our personal freedoms. From the Greatest Generation to Generation X, we get to make a difference in the lives of those individuals who unselfishly gave part of themselves for this country. I have worked with many excellent physicians during my time in the military. Some have stayed on active duty while others have left to work in the civilian sector. The decision to stay or leave the military is always multifactorial. There is not a simple formula of patriotism, intelligence, clinical skills, financial status, family issues or work ethic that can be applied to determine why someone would choose to leave the military. Just as civilian training institutions vary, there are undoubtedly differences between each of the services and their various training programs. I have been very grateful for the training I received at USUHS and subsequent residency and fellowship opportunities. I am satisfied with the career path I have taken. As demonstrated by this string, though, the practice of military medicine is not for everyone. I would recommend that prospective HPSP or USUHS students research a variety of programs and personally talk to military physicians on both sides of the aisle before coming to a conclusion.

Tim Biega, MDMAJ/USAILE Class 09-002, Ft. Gordon, GA

The comments in this posting do not reflect the views of the US Army Medical Department, CGSC, The Department of the Army, or the Department of Defense

Will you stick around after you complete your homework assignment? I hope so because otherwise I'm not sure there is any point to these posts. I have to admit I couldn't read your entire manifesto but I have a couple of questions for you.

1. As a neuroradiologist, do you enter your reports directly into AHLTA or are you permitted to freely dictate with a transcriptionist?

2. How far into your 20 years do you reach the end of your obligated service? Are you there now?

Most Army radiology departments are moving away from transcriptionists and towards voice recognition software. The reason behind this is rapid report turnaround and presumed cost savings. I actually have mixed feelings about voice recognition.

Currently, I use voice recognition software which is directly integrated into our PACS. The report is then uploaded directly into CHCS (I) which then populates AHLTA. If I were to directly input reports without voice recognition, I would type then directly into CHCS (I). I actually don't interface with AHLTA at all.

I owed 9 years after completion of my fellowship (7 for USUHS and 2 for fellowship training), so I would have 16 years in before I can consider leaving.

Please, please, please throw away the application for HPSP. As a current practicing active duty doctor, I can tell you that taking the HPSP scholarship was without a doubt the single worst thing that I have ever done or will do in my lifetime.

I don't want to get into to many details about myself, but suffice it to say that I am currently active duty, I have "served" 3 years, and I have 1 year remaining. I am in a subspecialty.

I am someone that likes to work hard. I enjoyed working long hours during residency and fellowship. I like to take care of challenging patients. I enjoy challenging myself. The military is CLEARLY NOT INTERESTED IN THIS.

Even if you completely ignore the difficulties raised by deployments, the ridiculously low salaries, and the bureacracy, the fact remains that the military does not want people that are interested in working hard.

If you are someone who would be happy with seeing 10 patients a day once or twice a week...or if you are a surgeon, operating once a week...then this would be the perfect job for you. Most of the people that I have met who have stayed in either have very long commitments or do not enjoy working hard and would never ever make it in the outside world.

I, on the other hand, am a horrible officer. I like to work hard. I don't think the clinic should shut down at 2 PM so everyone can go home, or retire to their office to do "paperwork". I don't agree that you can only do 2-3 cases in the OR per day because you're unwilling to have your nurses or techs stay later. I thought the purpose of being a doctor was to help people regardless of what time of day it is.

Ramstam, I implore you not to join. Once I am out, in a few years, I plan on starting a scholarship just for people like you who are considering throwing away their lives and their careers with HPSP. If I can get through to just one person, I will really feel like I have done some good. Don't waste your life and your future. Think about your potential and your happiness. The military certainly will not.

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I know I am quotting you from way back but anyone willing to answer please help.
I've recently signed theHPSP contract, but after reading much of vicious comments on this blog, I called the recruiter and told him not mind on my case. He did not say much. I am now worry on the loan I may mount for my education. with three children and my husband going for law school at the same time I don't even know if any one will be willing to borrow us extra besides tuition. I am a minority student and I still have not found any help out there
PS do yall with qualified judment think the army can come back at me? I sign the contract but school will start until fall so I have not received any money.

I know I am quotting you from way back but anyone willing to answer please help.
I've recently signed theHPSP contract, but after reading much of vicious comments on this blog, I called the recruiter and told him not mind on my case. He did not say much. I am now worry on the loan I may mount for my education. with three children and my husband going for law school at the same time I don't even know if any one will be willing to borrow us extra besides tuition. I am a minority student and I still have not found any help out there
PS do yall with qualified judment think the army can come back at me? I sign the contract but school will start until fall so I have not received any money.

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One has to wonder how the hell you were admitted to medical school with that level of incoherent writing.

One has to wonder how the hell you were admitted to medical school with that level of incoherent writing.

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Perhaps I should have proofed my post, but I did not know that you were reading it. As far as "How the HELL I was admitted to medical school?" First, I and others do not appreciate your profanity. As this may be a favorite redneck expression, I take it as an insult.
I have been admitted to medical school because of my accomplishments.
I grew up in one of the poorest countrys in the world and yet managed to get where I am today. I speak five languages the last being English so please excuse the imperfections. I came to America and earned my BS degree in three years when it takes most four. These are just a couple of the contributing factors.

Although, my english may not be perfect, I do not think it should be used as an invintaiton to slam someone whom you know nothing about.
I just reread my post and nowhere in there did it say, "Hey do you think I should have been admitted to medical school?"

If you don't have an answer to the question I asked, your silence would be appreciated by all.

If you are an American citizen - then you are eligible plain and simple. I don't see how they could reject you on the basis of citizenship if you are - indeed - an American citizen. I wouldn't worry about that.

I know I am quotting you from way back but anyone willing to answer please help.
I've recently signed theHPSP contract, but after reading much of vicious comments on this blog, I called the recruiter and told him not mind on my case. He did not say much. I am now worry on the loan I may mount for my education. with three children and my husband going for law school at the same time I don't even know if any one will be willing to borrow us extra besides tuition. I am a minority student and I still have not found any help out there
PS do yall with qualified judment think the army can come back at me? I sign the contract but school will start until fall so I have not received any money.

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Good for you. You did the right thing, and in military medicine, ( and elsewhere), you will meet many "rednecks" and you have to deal with them just like you did. Make sure you do not own anything to the army. Struggle for a while with loans and lack of money, but as you become an attending, you will reap the benefits of your sacrifice. Medicine is no longer a career to get rich in, but depending on what you choose, you will be comfortable.

When I applied for Army residency, I did not match and was able to take a civilian transitional internship. I reapplied for the match and again did not match in the Army, and was not allowed to take a civilian residency because it was in a different specialty than my original application. The Army chose to put me on active duty as a GMO rather than as a fully trained physician.
I was placed in a Brigade "Surgeon" position, overseeing 6 PAs and the medical care of 4000 Soldiers. Within 3 months I was in Iraq for a 15 month tour. My work in Iraq was largely administrative, and I had very little patient care, which of course is not great right out of internship.
During deployment I reapplied to Army residencies and again was not selected, depsite all those that indicated the deployment would certainly get me in. And yes, my packed was competitive. When discussing my options with the GMO HR officer, I was offerred 4 possibilities; two in the same position at a different post with deployment, continue on in my current position with deployment, or as a flight surgeon in Egypt for 3 years. In order to make the most of my dwell time and not be forced to sell my home in a bad marked, I stayed in the same position.
Now back in CONUS, most of the PAs left the unit, and my role changed to a primary care physician. I've definately got some outpatient experience now.
Currently I'm getting ready to leave for Iraq again for another year plus deployment, and will likely be stop-lossed at the end because I'm set to ETS one month after our proposed return date, and extensions seem imminent.
Had anyone warned me that I would spending a four year break in residency training, and more than half of that in Iraq, I never would have taken the HPSP. I feel as though I've lost most of the skills internship taught me, and am highly considering doing an internship again before residency.
I can not speak for Army residency programs other than for my medical school rotations in them. They seemed very good to me at the time, however that was prior to the war. I was not given the opportunity for residency training, and my deployment gave me no additional edge.
Though the GMO program is no longer a policy in the Army, they are still utilizing the program. GMOs allow for fewer specialty trained physicians to deploy in these slots, thereby keeping them home to tackle the patient care situation at home (which is far more scrutinized). This way the undertrained physicians can care for the troops on the front line, where they are out of the public eye.